Ethics in Pediatrics

Question 1

Which criteria should determine whether therapies ought to be provide?

Answer 1

• Child’s Best Interests

- Proportional weighing of benefits and burdens

Question 2

Decisions maked by?

Answer 2

• Physicians (benevolent medical paternalism)
• Parents (Family/parental decisional autonomy)
• The infants/children/adolescent

Question 3

The principal decision maker is?

Answer 3

The children/adolescent once they have sufficient decison-making capacity.

Question 4

Exceptions for parental consent/permission

Answer 4

• Mature minor (sufficent maturity to consent)
• Emancipated minor (with adult rights -eg: married minor)
• Emergency tx
• Court ordered tx

Question 5

Standard of child assent

Answer 5

• Optimizing child’s understanding of his condition and proposed test and tx
• Seeking the child’s voluntary cooperation to the proposed care.

Question 6

Exceptions to confidentiality

Answer 6

• Client consent/waiver (autonomy)
• Court order
• Statutory duty (protection of life)
• Public interest (protection from harm)

Question 7

Conditions for Disclosure

Answer 7

• Clear risk to identifiable person or group of persons
• Serious risk of bodily harm or death
• Imminent danger

Question 8

Exceptions to duty to provide life-sustaining tx when there is consensus:

Answer 8

• Irreversible imminent death
• Tx clearly ineffective/harmful
• Limitation allows greater palliative care
• Unpreventable intolerable distress/suffering

Question 9

Is it permissible to withdraw artificial nutrition and hydratation?

Answer 9

Withholding or withdrawing ANH is both legally and ethically permissible.

Question 10

Is it permissible to administer medications that may shorten life?

Answer 10

4 conditions of the principle of double effect:

• The nature of the act is itself good or morally neutral
• The intention is for the good effect, not the bad
• The good effect outweighs the bad effect, the situation merits the risk of the bad effect
• The bad effect is not used as a means to achieve the good effect.

Question 11

Principle of double effect is

Answer 11

circumstances under which one may act in a way that has both good and bad consequences.

Question 12

Rapprochement Model is

Answer 12

Fusion of horizons

Brdging diverse outlooks

Question 13

Daily living with distress and enrichment

Answer 13

• Confronting parental responsability
• Seeking normality
• Conflicting social values
• Living isolation
• What about the voice of the child?
• Questioning the moral order

Question 14

Parental responsability: Struggling to be a ‘‘good’’ parent

Answer 14

• Parent as caregiver, advocate, activist, educator, case manager
• Confronting dependence
• Decisional uncertainty
• Impact on family relationships
• Continuous spectre of death
• Getting so much in return (child worth so much)

Question 15

Tragic dilemmas/irresolvable dilemmas cause:

Answer 15

Guilt, remorse, regret and moral distress.

Question 16

Strategies for reconciliation:

Answer 16

Ethics discussions, education and consultations.

Question 17

The ‘‘best-interest model’’ for examining ethical issues related to children cast as a passive role is attribute to 2 phenomena:

Answer 17

1. underestimation of the ‘‘maturity’’ of the children’s moral reasoning
2. the ‘‘adult-centredness’’ of the best-interests model.

Question 18

What is a common source of moral distress for nurses when caring for terminally ill children?

Answer 18

The aggressive tx giving to dying children.

Question 19

Societal belief affecting the care of a dying child?

Answer 19

Parents expect to die before their child (decision-making resulting to attempt to prevent child from dying)